Medicare Coverage of Cardiovascular Disease
Last Updated : 10/21/20194 min read
If you are enrolled in Original Medicare (Part A and Part B), you may know that each part covers different portions of your health care. Part A, or hospital insurance, may cover inpatient hospital stays, care in a skilled nursing facility or hospice, and some home health-care services.
Part B generally covers the medical portion of your insurance, such as lab tests, doctor visits, surgeries, and some medically necessary equipment and supplies. Part B may also cover preventive services, which include certain vaccinations, as well as tests and screening exams for early detection of diseases such as cardiovascular disease.
What Medicare coverage is available for cardiovascular disease?
According to the American Heart Association, cardiovascular disease is associated with a number of different conditions and complications. Heart attack and stroke, for example, are two life-threatening cardiovascular disease complications. Common chronic health conditions such as high blood pressure and diabetes increase your risk for developing cardiovascular disease.
Your Medicare coverage could include the tests, treatments, and procedures your health-care provider recommends. If you become acutely ill as a result of complications from cardiovascular disease, you may be admitted to a hospital for care; Part A generally pays allowable charges for hospital care less any applicable deductibles and coinsurance amounts.
Some people are able to manage and treat their cardiovascular disease on an outpatient basis, with regular visits to their health-care providers, and perhaps prescription drug therapy. In this case, Medicare coverage of doctor visits and tests may be supplied by Part B, less any applicable deductibles, copayments, and coinsurance. Note, however, that Original Medicare, Part A and Part B, include only limited coverage of prescription drugs. If your cardiovascular disease treatment involves prescription drug therapy, you may want to consider a Medicare Part D Prescription Drug Plan to help offset your medication costs.
According to American Heart Association, sometimes lifestyle changes, such as weight loss, increase in physical activity or smoking cessation, are an effective cardiovascular disease treatment. There may be Medicare coverage under Part B for certain services to assist you in making lifestyle changes to improve your cardiovascular disease. For example, Part B covers up to eight smoking cessation counseling sessions per year; you may be eligible to get these at no cost to you if your health-care provider accepts Medicare assignment. You may also be eligible for one cardiovascular disease counseling session per year at no cost to you with your Part B benefits.
Is there Medicare coverage for cardiovascular disease screening?
There may be Medicare coverage for cardiovascular disease screening tests your doctor orders for you. Part B generally covers a screening blood test for lipids, cholesterol, and triglycerides once every five years to identify potential risk factors for cardiovascular disease.
In addition, Part B typically covers blood pressure screenings at your doctor’s office, and may cover screening tests for diabetes if you are at risk for developing the disease. The American Heart Association considers diabetes to be one of the seven most common risk factors for developing cardiovascular disease. Other risk factors (which diabetics may also have) may include hypertension, abnormal cholesterol, obesity, lack of physical activity, high blood sugar and smoking.
If you have cardiovascular disease, or are at high risk for developing it, you may have concerns about Medicare coverage for your health-care costs. Medicare Supplement plans, offered by private insurance companies, may be available in your area. A Medicare Supplement plan may pay some or all of your Part A and Part B deductibles and coinsurance amounts and some even include annual limits on your out-of-pocket expenses.
Medicare Advantage plans offer an alternative way to get your Medicare benefits that many people with cardiovascular disease may find economical and convenient. While all Medicare Advantage plans must cover everything Original Medicare covers (except hospice care, which is still provided under Part A), they usually include other attractive benefits such as coverage for prescription drugs and wellness programs that may reduce your risk for cardiovascular disease. You must continue paying your Part B premium if you have a Medicare Advantage plan.
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